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WEDNESDAY, October 2, 2013 — Critical illness can cause severe problems, even after the worst is over. One often overlooked issue is the cognitive deficiencies that can arise after hospitalization, according to a new study published in the New England Journal of Medicine. People with critical illness, even those that are unrelated to the brain, often suffer from cognitive issues similar to those experienced by people with traumatic brain injuries or Alzheimer’s disease that can last for days, weeks, months or longer, the researchers, from Vanderbilt University, found.

The cognitive issues stem from a form of acute brain dysfunction known as delirium, according to the study. Delirium is a common, but often overlooked, reaction to critical illnesses that causes rapid-onset confusion and disorientation and can lead to long-lasting cognitive problems.

"As medical care is improving, patients are surviving their critical illness more often,” lead author Pratik Pandharipande, MD, professor of anesthesiology and critical care at Vanderbilt University’s ICU Delirium and Cognitive Impairment Group, said in a statement, “but if they are surviving their critical illness with disabling forms of cognitive impairment then that is something that we will have to be aware of because just surviving is no longer good enough.”

The researchers looked at 821 patients who were admitted to the ICU with critical illnesses, such as respiratory failure or septic shock, and found that 74 percent developed delirium during their hospital stay. The researchers administered cognition tests to these patients three months later, and found that of the people who developed delirium, 40 percent scored similar to patients with moderate traumatic brain injury and 26 percent scored similar to patients with Alzheimer’s disease. Many of these patients experienced impaired cognitive abilities for 12 months or longer.

Sandra Chapman, PhD, founder and director of the Center for BrainHealth at the University of Texas at Dallas, said the mechanisms of delirium development are poorly understood, but simply being in the hospital setting could play a role.

“Many critically ill patients report losing a sense of time while hospitalized, so orienting individuals in a peaceful environment may help,” Dr. Chapman said. “Genetics also play a role in that there are individual differences on how each person¹s brain is genetically wired.”

In addition, severity of the injury and length of delirium were both linked to an increased severity of cognitive problems, according to the study.

“Research has shown a similar pattern in traumatic brain injury patients,” Chapman said. “Medical professionals must be deliberate and proactive to rebound the brain after hospitalization.”

Unfortunately, many doctors fail to check for cognitive decline in their critically ill patients, Chapman said, mostly because many doctors think it’s not possible to help.

“Brain health and cognitive impairment are neglected areas of medical treatment when the priority of hospitalization is physical health,” she said. “That said, because brain science is such a rapidly developing frontier, we did not know 10 years ago that the brain could rebound and repair after significant cognitive decline. We now know that is possible.”

One of the best thing doctors can do is monitor their critically ill patients for signs of decline after they are released from the hospital, Chapman said.

"It is important for doctors and patients to consider and treat cognitive health proactively,” she said. “Getting a benchmark of a patient's cognitive health before treatment will allow physicians to monitor cognitive decline, just as we monitor other benchmark measurements such as cholesterol.”

“Short-term cognitive training, 12 hours of directed training, not only improves cognitive performance but also increases brain blood flow which is an indicator of brain health,” she said.

“We now know that the brain can be impacted dramatically and quickly in both good and bad ways,” Chapman added. “Just as cognitive performance declines, it can also be treated and improved with the right intervention, much like physical therapy is used to improve mobility and physical performance. Our brain can be trained to think better.”

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